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THE PRESERVATIVE ACTION OF ARSENIC.
1244 Miss Alice Lucretia Ernst, M.D., in charge of the Ackerman Hoyt Memorial Hospital, Jhansi, United Provinces. Miss Margaret Mitchell Paterson, M.B., Scotch Mission Hospital, Sialkot, India. John Edward Sandilands, M.C., M.D., D.P.H., lately Health Officer, Bombay Municipality (posthumously). Hassan Suhrawardy, O.B.E., M.D., F.R.C.S., Chief Medical Officer, Eastern Bengal Railway. The following names will be recognised with
in the Birthday Honours, as their owners have worked in relation to medicine in one capacity or another. Among the knights will be found the
pleasure
names of Prof. J. Arthur Thomson, Regius professor natural history at Aberdeen, and Prof. A. S.
in
the famous astronomer. Miss Margaret McMillan has been made a Companion of Honour In for services to the nursery school movement. the Order of the British Empire, Miss Wilhehnine Walker, principal matron of Queen Alexandra’s Imperial Military Nursing Service, receives the military O.B.E., while the civil O.B.E. has been awarded to Miss Emily MacManus, matron of Guy’s Hospital; to Captain A. G. Elliott, secretary of the Mr. Russell Paton, London Hospital; and to organising secretary of the Royal Infirmary, Edinburgh. The Royal Red Cross of the first class has been awarded to Miss Agatha Mary Phillips, principal matron of Queen Alexandra’s Imperial Military Nursing Service, and to Miss Katherine Christie Watt, matron of Princess Mary’s R.A.F. Nursing Service. In the same service Miss Esther Wilson Hunter receives the Royal Red Cross of the second class.
Eddington,
____
REPORT ON THE LÜBECK DISASTER. Prof. Bruno Lange’s report to the German Health Office has appearedwith commendable promptitude in order to prevent (in the Elizabethan sense) hasty judgments on a distressing situation. It emanates from the Institute Robert Koch in Berlin with the added authority of Prof. Ludwig Lange. Up to the date on which the report was written 14 deaths had occurred at Lubeck in causal relation with the administration of B C G vaccine ; four deaths among this group of infants were due to other causes. Clinically and pathologically the picture was typical of tuberculosis acquired through the digestive tract with generalisation in the internal organs, the portal of entry being the pharynx, nasopharynx, or intestine. Prof. Lange comments on the remarkably short, incubation period, about four weeks, death following vaccination within a period of two months ; further deaths must be expected for a month or so, as the vaccine was given until the end of April, and it is the administration during March that accounts for the fatal cases so far reported. These cannot be debited to a particular batch of vaccine prepared on a particular day ; every batch was alike in its result. If some individual child escaped, this is to be attributed not to the vaccine but to the exceptional resistance ofthat child or to the accident of the vaccine having been vomited or (conceivably) not having been taken. The mortality was due, Prof. Lange does not doubt, to virulent tubercle bacilli abundantly present in the vaccine. How they got there he cannot say, nor does he hold out much prospect of being able to say, for the original material from the Pasteur Institute as well as the first subcultures are no longer available. A striking feature of Prof. Lange’s report is the short work he makes of the supposition that the harmless bacteria in B C G vaccine have regained their original virulence. The experiments which led Pirquet to give up the Calmette method were based on guinea-pigs which were made ill by the injection of very large doses of B C G culture. Petroff’s belief that he was able to cultivate virulent bacilli from B C G culture colonies was, he thinks, invalid ; the same colonies examined 1
Deut. Med. Woch., May 30th, p. 927.
at
the Koch Institute showed tubercle bacilli of human type--evidently a contamination, for bovine bacilli are never transmuted into human. The Institute has never been able to detect the slightest enhancement of virulence in many hundreds of vaccinated guinea-pigs, and its series of autopsies on lambs inoculated immediately after birth which showed no trace of the spread of tuberculosis. Isolated records of death in the literature are regarded as equally unconvincing. On this survey of his own work and of similar work elsewhere Prof. Lange rules out the possibility at Lubeck of a spontaneous conversion of harmless into pathogenic form of B C G. This assurance is in harmony with the Belgian 2 of massive doses of B C G vaccine administered subcutaneously to pregnant guinea-pigs without affecting mortality or development of offspring. But convinced as he is of the harmlessness of B C G Prof. Lange has no illusions as to its proved value. Opinion in Germany is not so optimistic as in France and does not find in the French statistics material for a trustworthy judgment. The protective action of the vaccine in guinea-pigs, rabbits, and monkeys has proved to be very limited, indeed hardly appreciable after oral administration. Whether appreciable success is to be obtained in man is still, he thinks, in doubt; but, he adds, " the slight addition to resistwhich we can give to the human subject by means of an immunising dose will in all probability make itself more obvious the higher the grade of natural resistance which the inoculated person possesses." This it is that justifies a test of the Calmette method under State control, the cultures
report
ance
being prepared only in large special laboratories. In the fight against tuberculosis, the report concludes, we cannot afford to discard a remedy in itself harmless from which any result is to be
expected.
THE PRESERVATIVE ACTION OF ARSENIC. THE discovery of arsenic in the bodies of persons who have been poisoned by it after long periods of interment is a well-established fact. The same is true of antimony and in a less degree of other toxic elements. In the tissues generally it is comparatively easy to discover arsenic in such cases, although it may not be found in the chemical form in which it was administered during life, in the alimentary canal especially, owing to the interaction of sul-
phuretted hydrogen generated during decomposition. Some of it will be in the form of sulphides. In some recorded cases the preservative effect on the tissues was easy to observe. An early instance, narrated in the Annual Register of the Year, 1829, has been brought to our notice by Mr. W. H. Woodzell, of Plymouth. The case occurred at Lyons in 1822, and the facts are briefly these. Suspicion having arisen that death was due to poison administered by the dead man’s daughter, two physicians of Lyons, Drs. Ozinam and Ide, were instructed in 1829 by the legal authorities to disinter the body and make an analysis of the remains. Orffla, the famous French chemist, had previously been asked if a body removed from the grave, after the lapse of such a time as seven years, could possibly afford proof of poison having been administered, and, if so, in what manner an investigation was to be conducted. His opinion in reply was that although the body would probably already be reduced to ashes, nevertheless, if a blackish deposit should be found at the sides of the spinal column, chiefly in the dorsal and lumbar regions, it might be analysed in the manner described in his works on toxicology. The coffin containing the remains was entire. It was composed of thick planks of fir or pine, which internally were found to be quite dry. On exposure of its contents, the body was recognised by the priest, by the gravedigger, and by some of the National Guard who had assisted at the 2 Nelis, P.: 1930, p. 729.
Bull.
de
l’Off.
Internat., d’Hyg. pub. April,
1245 interment and had fired over the grave. It was abundantly shows this. Similar effects had been identified by the hair which yet remained and by the previously noted in the case of Palmer in 1856, and teeth, all of which were still in their sockets except also that of Captain Caw poisoned by his son-in-law one which had been lost during life. Head, trunk, and in New Zealand. limbs were entire, so that the stature could be measured. The chest had fallen in and the heart and A RECEPTION BY THE ROYAL SOCIETY lung tissues had become blended together, presenting the appearance of a dark oleaginous substance. The OF MEDICINE. whole was without smell. The entire trunk was then A WELL-ATTENDED reception was held by the Royal removed-the head and extremities being regarded of Medicine on May 29th, when Lord Dawson, Society The to the as unnecessary investigation. portion reserved for examination weighed nine pounds, of as President of the society, received the guests with which two pounds were set aside for a second set of Lady Dawson. In the course of the evening two were shown ; the first, Turksib," was a Rusexperiments lest those made on the first should prove films the construction of a railway in sian showing picture In the Drs. Ozinam investigation, unsatisfactory. and Ide proceeded on the supposition that arsenic Turkestan. This, like other Russian films which havee reached this country, was an artistic and clever was the poison. The railway was presented as almost The matter was first boiled, and the fluid therefrom production. it was due to be completed in 1930, as for finished, evaporated to dryness, the residuum thus obtained being the audience was repeatedly told ; but in actual fact dissolved in distilled water. This produced a deep-coloured stage of developliquid which, treated with chlorine, was but imperfectly it is still, we understand, in an early not will be finished this and most of its The distilled colour. water with this certainly ment, deprived charged extract from the remains was again evaporated to dryness, year. It was interesting to notice that the big and four ounces of potassium nitrate, placed in a matras, machinery being used in the construction was English ; were exposed on ignited charcoal. The suspected matter also that sheep, cattle, and horses have been imported well-dried and after rolling it into little portions, was intro- from England to stock the country through which duced. Each time this was done a deflagration was produced an amusing and perceived. It was now allowed to cool and the residue the railway is to run. The second film was comedy, entitled " Habeas Corpus," and provided a was again dissolved in distilled water. This resulting solution was now saturated with nitric acid and afterwards subjected pleasant contrast to the more serious picture. The to the usual reagents, all of which indicated the presence of popularity of these social evenings has increased to arsenic. Some small portions were treated with vegetable such an extent that many applications for cards have charcoal introduced into a glass tube and then heated. This to be refused for lack of accommodation. It is a gave off aqueous vapour at first, soon after which small grey- tribute to the attractions offered by the society that coloured and brilliant points were seen. A grain of metallic arsenic was thus obtained. Another portion treated with this is true at the very height of the London season. hydro-sulphuric acid furnished sulphuret of arsenic and this, when heated and acted upon by caustic potash, afforded a portion of shining matter which was easily dissolved in distilled THE VIRUS OF PSITTACOSIS. ____
"
water
by directing
upon it
a
current of oxygen gas.
THE claim that certain of the so-called filtrable
By these various experiments the fact of a consider- viruses can be demonstrated by the current microable quantity of arsenic having been administered scopical methods is no new one. The bodies described seven years earlier was demonstrated. From the by Paschen, Borrel, and others in virulent vaccinia ability of witnesses to recognise the features after seven material are, perhaps, the best known example, but years’ burial it is clear that the preservative effect of similar appearances have been observed in connexion the arsenic had been remarkable. Since that time other cases have established this effect, which has long been recognised by medico-legal writers. Instances are given in the text-books of Dixon Mann and R. T. M. Buchanan, while J. Glaister cites in detail the appearance of the victims of Flannagan and Higgins who were tried at Liverpool in 1884. By reason of arsenical poisoning having been established in one of the three victims, the bodies of two othersMary Higgins, aged 10, and John Flannagan, aged 24-were exhumed and examined. Although the body of the former had been buried for about 13! months, and that of the latter for 37 months, both were found to be in an excellent state of preservation ; indeed, in the case of John Flannagan, the face and body generally could easily be identified. The abdominal organs of Mary Higgins were found on analysis to. contain one grain, and those of John Flannagan, 34 grains of arsenious acid. Another noteworthy appearance found after burial in the stomach and intestines of the bodies of those to whom arsenic has been administered and which, moreover, was also observed in the bodies of the above-named individuals, is a golden-yellow pigment or coating of the mucous membrane. It has been contested whether this yellow pigment is composed of arsenic sulphide or of yellow bile-pigment. Campbell Brown and Davies analysed the pigment in these cases and found that it did not contain any appreciable amount of arsenic, but chiefly consisted of bilepigment. On the other hand, Littlejohn and Drinkwater have recorded two cases of poisoning with arsenious acid in which the yellow sulphide was found in the alimentary canal. Like preservative effects on the bodies of victims of poisoning by antimony are also well established. The account of the bodies in the Chapman or Klosowski case exhumed in London (1903) by the late Sir Thomas Stevenson,
with other members of the group, such as the viruses of fowl-pox, influenza, poliomyelitis, and dengue. Opinion is sharply divided on the nature of these bodies. They are not easily stained, and do not reveal themselves to casual or haphazard study, which probably accounts for the lack of attention which they have received, many investigators having dismissed them after a cursory examination as precipitate of stain or protein. Nevertheless the view that they are the viruses is held by many whose opinion is entitled to respect. Recently bodies of a somewhat similar nature have been described in connexion with the virus of psittacosis. These appear most commonly as small cocci, 0’3 -0-4 fL in diameter, single or in pairs, but occasional bacillary forms are met with which may be as much as 2 fL in length. They are readily demonstrated by prolonged staining with Giemsa, but can be stained, though less well, with L6ffler’s methylene-blue or carbol fuchsin. Levinthal,l who was the first to describe them, does not commit himself on their relationship to other virus bodies, though he does throw out a hint of the ’, possibility of the virus of psittacosis being a member of the Brucella group ; apparently he considers these bodies to be the virus. Both Coles2 and Lillie.3 whose papers closely followed that of Levinthal, incline to the view that these bodies belong to the rickettsias ; in fact, the latter author goes so far as to coin the name Rickettsia psittaci. Undoubtedly there are strong resemblances with the rickettsias. The presence of bacillary forms, the appearance of the coccal and bacillary forms when stained by Giemsa, their occurrence in masses inside endothelial phagocytes, and the fact that they are Gram-negative, 1 Levinthal, W. : Klin. Woch., 1930, ix., 654.
2 Coles, A. C.: THE LANCET, May 10th, p. 1011. 3 Lillie, R. D.: U.S. Pub. Health Rep., 1930, xlv, 773.
in the Birthday Honours, as their owners have worked in relation to medicine in one capacity or another. Among the knights will be found the
pleasure
names of Prof. J. Arthur Thomson, Regius professor natural history at Aberdeen, and Prof. A. S.
in
the famous astronomer. Miss Margaret McMillan has been made a Companion of Honour In for services to the nursery school movement. the Order of the British Empire, Miss Wilhehnine Walker, principal matron of Queen Alexandra’s Imperial Military Nursing Service, receives the military O.B.E., while the civil O.B.E. has been awarded to Miss Emily MacManus, matron of Guy’s Hospital; to Captain A. G. Elliott, secretary of the Mr. Russell Paton, London Hospital; and to organising secretary of the Royal Infirmary, Edinburgh. The Royal Red Cross of the first class has been awarded to Miss Agatha Mary Phillips, principal matron of Queen Alexandra’s Imperial Military Nursing Service, and to Miss Katherine Christie Watt, matron of Princess Mary’s R.A.F. Nursing Service. In the same service Miss Esther Wilson Hunter receives the Royal Red Cross of the second class.
Eddington,
____
REPORT ON THE LÜBECK DISASTER. Prof. Bruno Lange’s report to the German Health Office has appearedwith commendable promptitude in order to prevent (in the Elizabethan sense) hasty judgments on a distressing situation. It emanates from the Institute Robert Koch in Berlin with the added authority of Prof. Ludwig Lange. Up to the date on which the report was written 14 deaths had occurred at Lubeck in causal relation with the administration of B C G vaccine ; four deaths among this group of infants were due to other causes. Clinically and pathologically the picture was typical of tuberculosis acquired through the digestive tract with generalisation in the internal organs, the portal of entry being the pharynx, nasopharynx, or intestine. Prof. Lange comments on the remarkably short, incubation period, about four weeks, death following vaccination within a period of two months ; further deaths must be expected for a month or so, as the vaccine was given until the end of April, and it is the administration during March that accounts for the fatal cases so far reported. These cannot be debited to a particular batch of vaccine prepared on a particular day ; every batch was alike in its result. If some individual child escaped, this is to be attributed not to the vaccine but to the exceptional resistance ofthat child or to the accident of the vaccine having been vomited or (conceivably) not having been taken. The mortality was due, Prof. Lange does not doubt, to virulent tubercle bacilli abundantly present in the vaccine. How they got there he cannot say, nor does he hold out much prospect of being able to say, for the original material from the Pasteur Institute as well as the first subcultures are no longer available. A striking feature of Prof. Lange’s report is the short work he makes of the supposition that the harmless bacteria in B C G vaccine have regained their original virulence. The experiments which led Pirquet to give up the Calmette method were based on guinea-pigs which were made ill by the injection of very large doses of B C G culture. Petroff’s belief that he was able to cultivate virulent bacilli from B C G culture colonies was, he thinks, invalid ; the same colonies examined 1
Deut. Med. Woch., May 30th, p. 927.
at
the Koch Institute showed tubercle bacilli of human type--evidently a contamination, for bovine bacilli are never transmuted into human. The Institute has never been able to detect the slightest enhancement of virulence in many hundreds of vaccinated guinea-pigs, and its series of autopsies on lambs inoculated immediately after birth which showed no trace of the spread of tuberculosis. Isolated records of death in the literature are regarded as equally unconvincing. On this survey of his own work and of similar work elsewhere Prof. Lange rules out the possibility at Lubeck of a spontaneous conversion of harmless into pathogenic form of B C G. This assurance is in harmony with the Belgian 2 of massive doses of B C G vaccine administered subcutaneously to pregnant guinea-pigs without affecting mortality or development of offspring. But convinced as he is of the harmlessness of B C G Prof. Lange has no illusions as to its proved value. Opinion in Germany is not so optimistic as in France and does not find in the French statistics material for a trustworthy judgment. The protective action of the vaccine in guinea-pigs, rabbits, and monkeys has proved to be very limited, indeed hardly appreciable after oral administration. Whether appreciable success is to be obtained in man is still, he thinks, in doubt; but, he adds, " the slight addition to resistwhich we can give to the human subject by means of an immunising dose will in all probability make itself more obvious the higher the grade of natural resistance which the inoculated person possesses." This it is that justifies a test of the Calmette method under State control, the cultures
report
ance
being prepared only in large special laboratories. In the fight against tuberculosis, the report concludes, we cannot afford to discard a remedy in itself harmless from which any result is to be
expected.
THE PRESERVATIVE ACTION OF ARSENIC. THE discovery of arsenic in the bodies of persons who have been poisoned by it after long periods of interment is a well-established fact. The same is true of antimony and in a less degree of other toxic elements. In the tissues generally it is comparatively easy to discover arsenic in such cases, although it may not be found in the chemical form in which it was administered during life, in the alimentary canal especially, owing to the interaction of sul-
phuretted hydrogen generated during decomposition. Some of it will be in the form of sulphides. In some recorded cases the preservative effect on the tissues was easy to observe. An early instance, narrated in the Annual Register of the Year, 1829, has been brought to our notice by Mr. W. H. Woodzell, of Plymouth. The case occurred at Lyons in 1822, and the facts are briefly these. Suspicion having arisen that death was due to poison administered by the dead man’s daughter, two physicians of Lyons, Drs. Ozinam and Ide, were instructed in 1829 by the legal authorities to disinter the body and make an analysis of the remains. Orffla, the famous French chemist, had previously been asked if a body removed from the grave, after the lapse of such a time as seven years, could possibly afford proof of poison having been administered, and, if so, in what manner an investigation was to be conducted. His opinion in reply was that although the body would probably already be reduced to ashes, nevertheless, if a blackish deposit should be found at the sides of the spinal column, chiefly in the dorsal and lumbar regions, it might be analysed in the manner described in his works on toxicology. The coffin containing the remains was entire. It was composed of thick planks of fir or pine, which internally were found to be quite dry. On exposure of its contents, the body was recognised by the priest, by the gravedigger, and by some of the National Guard who had assisted at the 2 Nelis, P.: 1930, p. 729.
Bull.
de
l’Off.
Internat., d’Hyg. pub. April,
1245 interment and had fired over the grave. It was abundantly shows this. Similar effects had been identified by the hair which yet remained and by the previously noted in the case of Palmer in 1856, and teeth, all of which were still in their sockets except also that of Captain Caw poisoned by his son-in-law one which had been lost during life. Head, trunk, and in New Zealand. limbs were entire, so that the stature could be measured. The chest had fallen in and the heart and A RECEPTION BY THE ROYAL SOCIETY lung tissues had become blended together, presenting the appearance of a dark oleaginous substance. The OF MEDICINE. whole was without smell. The entire trunk was then A WELL-ATTENDED reception was held by the Royal removed-the head and extremities being regarded of Medicine on May 29th, when Lord Dawson, Society The to the as unnecessary investigation. portion reserved for examination weighed nine pounds, of as President of the society, received the guests with which two pounds were set aside for a second set of Lady Dawson. In the course of the evening two were shown ; the first, Turksib," was a Rusexperiments lest those made on the first should prove films the construction of a railway in sian showing picture In the Drs. Ozinam investigation, unsatisfactory. and Ide proceeded on the supposition that arsenic Turkestan. This, like other Russian films which havee reached this country, was an artistic and clever was the poison. The railway was presented as almost The matter was first boiled, and the fluid therefrom production. it was due to be completed in 1930, as for finished, evaporated to dryness, the residuum thus obtained being the audience was repeatedly told ; but in actual fact dissolved in distilled water. This produced a deep-coloured stage of developliquid which, treated with chlorine, was but imperfectly it is still, we understand, in an early not will be finished this and most of its The distilled colour. water with this certainly ment, deprived charged extract from the remains was again evaporated to dryness, year. It was interesting to notice that the big and four ounces of potassium nitrate, placed in a matras, machinery being used in the construction was English ; were exposed on ignited charcoal. The suspected matter also that sheep, cattle, and horses have been imported well-dried and after rolling it into little portions, was intro- from England to stock the country through which duced. Each time this was done a deflagration was produced an amusing and perceived. It was now allowed to cool and the residue the railway is to run. The second film was comedy, entitled " Habeas Corpus," and provided a was again dissolved in distilled water. This resulting solution was now saturated with nitric acid and afterwards subjected pleasant contrast to the more serious picture. The to the usual reagents, all of which indicated the presence of popularity of these social evenings has increased to arsenic. Some small portions were treated with vegetable such an extent that many applications for cards have charcoal introduced into a glass tube and then heated. This to be refused for lack of accommodation. It is a gave off aqueous vapour at first, soon after which small grey- tribute to the attractions offered by the society that coloured and brilliant points were seen. A grain of metallic arsenic was thus obtained. Another portion treated with this is true at the very height of the London season. hydro-sulphuric acid furnished sulphuret of arsenic and this, when heated and acted upon by caustic potash, afforded a portion of shining matter which was easily dissolved in distilled THE VIRUS OF PSITTACOSIS. ____
"
water
by directing
upon it
a
current of oxygen gas.
THE claim that certain of the so-called filtrable
By these various experiments the fact of a consider- viruses can be demonstrated by the current microable quantity of arsenic having been administered scopical methods is no new one. The bodies described seven years earlier was demonstrated. From the by Paschen, Borrel, and others in virulent vaccinia ability of witnesses to recognise the features after seven material are, perhaps, the best known example, but years’ burial it is clear that the preservative effect of similar appearances have been observed in connexion the arsenic had been remarkable. Since that time other cases have established this effect, which has long been recognised by medico-legal writers. Instances are given in the text-books of Dixon Mann and R. T. M. Buchanan, while J. Glaister cites in detail the appearance of the victims of Flannagan and Higgins who were tried at Liverpool in 1884. By reason of arsenical poisoning having been established in one of the three victims, the bodies of two othersMary Higgins, aged 10, and John Flannagan, aged 24-were exhumed and examined. Although the body of the former had been buried for about 13! months, and that of the latter for 37 months, both were found to be in an excellent state of preservation ; indeed, in the case of John Flannagan, the face and body generally could easily be identified. The abdominal organs of Mary Higgins were found on analysis to. contain one grain, and those of John Flannagan, 34 grains of arsenious acid. Another noteworthy appearance found after burial in the stomach and intestines of the bodies of those to whom arsenic has been administered and which, moreover, was also observed in the bodies of the above-named individuals, is a golden-yellow pigment or coating of the mucous membrane. It has been contested whether this yellow pigment is composed of arsenic sulphide or of yellow bile-pigment. Campbell Brown and Davies analysed the pigment in these cases and found that it did not contain any appreciable amount of arsenic, but chiefly consisted of bilepigment. On the other hand, Littlejohn and Drinkwater have recorded two cases of poisoning with arsenious acid in which the yellow sulphide was found in the alimentary canal. Like preservative effects on the bodies of victims of poisoning by antimony are also well established. The account of the bodies in the Chapman or Klosowski case exhumed in London (1903) by the late Sir Thomas Stevenson,
with other members of the group, such as the viruses of fowl-pox, influenza, poliomyelitis, and dengue. Opinion is sharply divided on the nature of these bodies. They are not easily stained, and do not reveal themselves to casual or haphazard study, which probably accounts for the lack of attention which they have received, many investigators having dismissed them after a cursory examination as precipitate of stain or protein. Nevertheless the view that they are the viruses is held by many whose opinion is entitled to respect. Recently bodies of a somewhat similar nature have been described in connexion with the virus of psittacosis. These appear most commonly as small cocci, 0’3 -0-4 fL in diameter, single or in pairs, but occasional bacillary forms are met with which may be as much as 2 fL in length. They are readily demonstrated by prolonged staining with Giemsa, but can be stained, though less well, with L6ffler’s methylene-blue or carbol fuchsin. Levinthal,l who was the first to describe them, does not commit himself on their relationship to other virus bodies, though he does throw out a hint of the ’, possibility of the virus of psittacosis being a member of the Brucella group ; apparently he considers these bodies to be the virus. Both Coles2 and Lillie.3 whose papers closely followed that of Levinthal, incline to the view that these bodies belong to the rickettsias ; in fact, the latter author goes so far as to coin the name Rickettsia psittaci. Undoubtedly there are strong resemblances with the rickettsias. The presence of bacillary forms, the appearance of the coccal and bacillary forms when stained by Giemsa, their occurrence in masses inside endothelial phagocytes, and the fact that they are Gram-negative, 1 Levinthal, W. : Klin. Woch., 1930, ix., 654.
2 Coles, A. C.: THE LANCET, May 10th, p. 1011. 3 Lillie, R. D.: U.S. Pub. Health Rep., 1930, xlv, 773.